Basic Information
| Provider Information | |||||||||
| NPI: | 1023238672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALLER | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 HIGHLAND AVENUE | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173312297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176332144 | ||||||||
| FaxNumber: | 7176332221 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 BRUNSWICK DR STE 1200 | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173318350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176370470 | ||||||||
| FaxNumber: | 7176374987 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 01/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | OA002932 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | MA052072 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.